Condition and Prospects of the Medical Profession

June 9, 2016

Annual Oration 1847

By John Ware, M.D.

Mr. President and Gentlemen,

It was my original purpose, in addressing this Society to-day, to have fallen in with the general custom, and selected a subject exclusively of practical interest. But the circumstances of the times having turned the thoughts of many among us to the present position, relations, and prospects of our profession, it seemed not improbable that our attention might be profitably directed to the consideration of some topics closely connected with them. In the discussion of these topics I hope not to depart from the true purposes of our meeting, or to mistake the true objects for which we are associated. This Society was established in order that it might promote the well-being of the medical profession in the Commonwealth. But by this is to be understood not merely the well-being of physicians individually and as a body. In its original constitution, there is implied, if not directly enforced, a still higher function. It is in all respects the responsible guardian of the medical profession. It is intended to gather together and to keep together all practitioners in one uniform body; to take means to give them the highest possible medical education, and ensure them the highest possible personal character; to do it equally with regard to all, in all parts; and to do it in such manner, that the community shall have cause to repose confidence in the spirit in which it is done, and in the results which are brought about.

For it is to be recollected, that we are not constituted by our own act, or mainly for our own interests. Physicians do not exist of themselves or for themselves. Their existence is not in itself a benefit. It grows out of a certain necessity in the community, which renders them only indirectly useful, inasmuch as they furnish the remedy of an evil. And so of our Society. It was not formed chiefly for our sakes. Privileges were not conferred upon us chiefly for our advantage. The ultimate object was the benefit of the community. Mankind require, for their comfort and safety, a body of well-educated and conscientious physicians. As the surest means of accomplishing this purpose, they have commanded us to associate together; and, giving us certain duties to perform, have also endowed us with certain privileges to induce us to their performance.

We should take, therefore, a very insufficient view of the objects of our organization, if we regarded it as existing merely that we may come together, once a year, to take each other by the hand, to consult concerning our common interests, to establish regulations for our intercourse with one another and with our patients, to administer discipline if it should be necessary, to hear an annual discourse, and to assemble in a kindly and fraternal spirit around the social board. These, it is true, are worthy purposes, and they alone would have been enough to justify the existence of our association. But we still have another object, because we have another relation than that which we bear to each other—namely, that which we bear to the community that has called not only our Society, but our profession into existence, and for which we may be said to live and move and have our being. Our first and highest responsibility is to this community. Our great duty is to see that its interests are attended to. The mode and character of our organization, our policy, and our attention to our personal interests, are only so far commendable, as they do not interfere with, but rather tend to promote, this great ultimate purpose.

And fortunately, as it happens, not only are these two things not inconsistent, but the means promoting the one are those also which will tend most certainly to the promotion of the other. There are abundant evidences in the proceedings of this Society, that the principle I have stated has neither been forgotten nor neglected. But it is a weakness from which none are free, that, when zealously engaged in the attainment of any end which requires a complicated and extensive organization of means to bring it about, we are apt to overlook the paramount importance of the end, in the interest which becomes attached to the means. This weakness displays itself both in small things and in great. We see it in little societies established for the most trivial of purposes. We see it in those organizations which decide the policy of nations. Thus the profession of arms comes to be considered as a pursuit worthy of existence for itself. Thus governments, in all ages and of all kinds,—Monarchical, Ecclesiastical, and Republican,—after a while come to believe that the people are for them, and not they for the people,—that they have an existence independently of those who really created them,—that this existence is in itself a good,—and that they thus have inherent rights of their own.

We can scarcely hope to have kept ourselves entirely free from so universal a tendency, however insensible we may have been to it, and however we might shrink from its intentional indulgence. It can hardly have happened, in our earnest and proper cultivation of an esprit du corps,—in taking measures to ensure regularity and discipline within, and to prevent encroachments from without, our ranks,—that we have not sometimes erred in confining our regards too much to our own organization,—our own independent existence,—our own interests. Whether this have been so or not, if merely the danger of it exists, it cannot be without its use from time to time to review our position and our relations,—to go back to the first purposes of our existence,—and thus to refresh in our minds the knowledge of the principles which should guide us, and the duties which devolve upon us. We are the guardians, as I have said, of the medical character; we are appointed to watch over the interests of society in this particular; to us the public look for assurance that they will be faithfully served, in some of the most important and interesting relations of life. Our great and ultimate purpose should then be to perform this duty well; to adopt such a policy, and take such measures, as will secure to the community an improved and improving medical profession,—as will give to its physicians, now and in future, the highest possible social, intellectual, professional, and moral character. It is thus, indeed, that we shall in the end best promote our own interests. It is thus, that we shall at once show our sense of the true excellence of our calling, and manifest to the world that in which its true worth and dignity consist.

It will not be amiss to suggest here certain circumstances, in the condition and prospects of the medical profession in such a community as ours, which should operate as strong motives to give the subject, in this point of view, our earnest attention. Our profession holds, in a country with such institutions as ours, a far other and more important relation than elsewhere. Where there is hereditary rank, or where there are certain classes of men with a defined position in society, transmitted from generation to generation, either as the inheritance of blood or of fortune, the mass of mankind look up to such classes as their leaders, as their models;—always, certainly, in customs, manners, and all those lighter arrangements which give a charm and elegance to human intercourse; and too often, also, in morals and religion. Now, among ourselves, we may scorn as we please the imputation of social inequality, and assert that, as no class has the right, so none has the power, to exercise among us this sort of social influence. But it is not so, and, constituted as mankind are, it cannot be so. The bulk of men do, and must, think and live on authority and by imitation. They look upward, somewhere, for models in opinions, in manners, in morals. We have pulled down the idols of silver and gold which are worshipped in the old world, and are proud of our own purer political devotion. Let us be sure that we do not put up in their stead idols of iron and clay.

Now, our profession is, and, in this country, always must be, one of those permanent classes which exercise a wide social influence. We are not, as in some other countries, a class, honored indeed to a certain extent, but still subordinate to the aristocracy, to the landholders, even to the gentlemen of the land. We are here of the aristocracy,—I use the term in no offensive sense,—we are, or ought to be, among the gentlemen of the land. There is an influence in this relation, which we must exert, whether we will or not. Surely this is one of the responsibilities that should excite us to establish such a standard of education, manners, and character, as will make that influence a salutary one.

The condition and character of the community to which we belong, not only presents us with a powerful motive, but at the same time offers us the best opportunity and the highest rewards, for aiming to establish a high standard in our profession. On the whole face of the earth, you can hardly find a spot which contains within itself the elements of so favored a lot. Our Commonwealth, though small in extent, has a population large enough for energetic undertakings, and yet not too large for the maintenance of a steady and uniform social character. Though our soil is barren, and our climate harsh, they still do not refuse a sufficient return to that industry which is stimulated by the very obstacles they present. These obstacles, indeed, excite a spirit of intelligence and enterprise which exhibits itself in the developement of countless sources of wealth and comfort, that do not depend upon soil or climate, but on a persevering will, for their existence, and ensure to us an increasing prosperity with an increasing population. Then, by means of a system of intercommunication, gradually penetrating to every corner of our territory, we are practically compressed into a space so small, that each man may almost call every other man his neighbor, and feel his influence either for good or for evil. Beside all this, there were early implanted here, by those who founded our community, high political, moral, and religious principles, without which the best advantages of soil and climate and situation are worthless.

In its progress and present position we witness results which are the legitimate effects of the circumstances that have been enumerated. I do not refer merely to a worldly prosperity almost unexampled, when compared with our original physical advantages, but to results of a more important kind. Where have the principles of constitutional liberty been better understood, or more ably defended, or received a stronger forward impulse, than among the people of Massachusetts? What community first set the example of the abolition of African slavery? Where originated the modern movement against the barbarous custom of war? Where the temperance reformation? Where are the interests of general education more sacredly guarded, and its principles investigated and illustrated with more earnestness and perseverance? Where has there been any earlier, or at least more zealous exhibition of that improved humanity, which has mitigated the punishment of crime,—has aimed to make the law a reformer instead of an avenger,—devised improved systems of prison discipline, and soothed instead of exasperating the fury of the maniac? Where is there any community which can show so many devoted spirits striving to elevate the intellectual, social, moral, and religious condition of mankind,—many of them no doubt with an intemperate and uncharitable zeal, but still always with the essential purpose, at the bottom, of doing good?

Who can doubt of the onward progress of such a community as this?—and is it not our part to do something in this great work, and to keep the standard of our profession up to that of every thing about us? Shall we fall behind others in this enterprize? Shall we not partake in that spirit of the age, whose watchwords are Improvement, Progress, and Reform?

There is yet a further reason, and one more peculiar to ourselves, why we should at this time pause to look out our position, with the purpose of defining to ourselves the design and spirit which are to guide us in our course. We are not to conceal from ourselves the fact that this position is different from that which we once held. Formerly, though often the subject of ridicule and satire, medicine was looked upon by the mass of mankind with a veneration almost superstitious, as it still is among savage nations. In times long since past, there was supposed to be something recondite, mysterious, far above the apprehension of the vulgar, in the knowledge of physicians. The oracular air and the dictatorial authority which they assumed, were submitted to as rightfully belonging to those who possessed secrets of nature and art of an almost supernatural character. And, more recently, although the excess of this feeling had passed away, there still remained a prestige around the profession, which gave its members a sort of authority over the minds of men in their peculiar vocation, resembling that possessed by ecclesiastics at the confessional. But this has nearly ceased. Indiscriminate reliance on authority no longer exists. To assume it, would expose us to derision. The confidence of mankind, as a mass, in the regular profession, has changed its character, and has probably much diminished. So far as it remains, it depends more on personal regard, and reliance on the individual, than upon any general high appreciation of medical knowledge. How ready are people of all classes to trust themselves to men of imperfect education, if not of equivocal character! How ready are those of even good education and intelligence to set themselves up as final judges upon questions with respect to which men of the largest capacities, trained from youth to the study of such subjects, and grown gray in watching disease, find it very difficult to get at the truth!

So much is this the case, that some among us have at times entertained fears with regard to the stability and permanence of our profession, as at present constituted; and, rendered timid by the signs of the times, have seriously apprehended that we are to be sooner or later supplanted by some new medical dynasty, if I may so call it. At the same time many, out of the profession, the proselytes of some recent sect, have, almost exultingly, prophesied, that at no very distant period the new system, to which they have given their adhesion, will establish itself upon the ruins of the old.

But, while I have not the slightest apprehension of this result, and, on the contrary, the most unlimited confidence in our stability and permanence, yet, since it is impossible not to admit the reality of the change to which I have adverted, we are, I think, imperatively called upon to consider seriously our present condition, and to call up for reflection the principles of conduct which will contribute most certainly to establish the profession in future upon an honorable and enduring foundation. And we may remark, in the first place, that, whatever may have been the merits or demerits of the members of our calling, it has not, in point of fact, been from a knowledge of the former, that the confidence of mankind has been given them,—nor from a discovery of the latter, that it has been taken away. Those who once bestowed their confidence were no competent judges whether it were deserved; those who have now withdrawn it or diminished it, are as little capable of appreciating the qualifications of those upon whom they sit in judgment. It proceeded from that blind reliance upon prescription and authority, which led men to accept upon trust many opinions, and suffer the existence of many institutions, which had no other foundation. This is a species of confidence, which, among the progressive portion of mankind, is not now reposed in any thing. Neither in law, in government, in morals, nor in religion, is such authority recognized. Every thing is made subject to careful scrutiny,—its foundations are examined,—its truth is tested. Everything is presumed to be capable of improvement. And if on any subject there exists, or is fancied to exist, in those connected with it, a disposition to oppose the operation of the principle of progress,—a disposition to cling too closely to the past,—there will result, as a natural consequence, distrust and want of confidence. Such a disposition does exist, with regard to all subjects; and, although in many persons, on the one hand, the spirit of improvement degenerates into an indiscriminate zeal for novelty and change,—a desire to destroy one thing merely because it is old, and to substitute another merely because it is new,—yet it is equally true, on the other hand, that there is a class, in whom the opposite tendency predominates; who resist all proposed improvement merely because it is new, and cling pertinaciously to the shadows of the past merely because they are old.

In all professions and occupations, such a class exists, and it is not strange that they should be the occasion of distrust, especially when, as in our pursuits, so many things present themselves, which are at first calculated to startle the inquirer, and lead him to believe, on a superficial examination, that there can be no truth and no certain knowledge, where there is so much disagreement, and so much doubt, upon what seem to be essentials. He sees, that, from time to time, the most opposite theories have held sway over medical opinions and practice. He hears those of one school, or of one age, denouncing as absurd and hurtful, doctrines, which those of another regard as sacred for their truth, and inestimable for their practical benefits. He hears one man, or one set of men, proclaiming, as destructive to health and life, modes of practice which others regard as indispensable for their preservation. He perceives how much of our knowledge, as to the nature, causes, and treatment of disease, is admitted, by the best informed, to be uncertain,—what differences of opinion consequently exist among the wisest: this uncertainty and these differences seeming to increase as our knowledge really increases. It is not strange, while this is found to be the case among those who were once looked up to as oracular and infallible, that distrust should creep in, and the actual amount of certain knowledge come to be undervalued.

We have been often reproved for our errors, our mistakes, our disagreements, our uncertainties; but I still think medicine will bear a comparison in its history, and in its present condition, not only as to the spirit of truth and humanity with which it has been pursued, but also as to the results which have been attained, with any branch of human inquiry, when the difficulties which surround its investigations, and the circumstances under which the comparison is made, are taken into consideration. It stands, in relation to its studies, on an entirely different ground from any other science. In its practical departments especially, the investigation of disease and the application of remedies, we are interfered with by the influence of circumstances, which have no place in other scientific inquiries, and which confuse and embarrass the judgment. Moral elements constantly mingle in; and, whilst they change the conditions under which the inquiry is to be prosecuted, they at the same time prevent that cool and dispassionate state of mind which is so necessary to a fair result. Hope, fear, impatience, anxiety, imagination, pride, and even superstition are constantly combined with the pure physiological materials, incapable of being appreciated if perceived, and often unperceived by the observer, when they are producing their full influence upon the patient. These circumstances in practical medicine combine to render it a more difficult subject for judgment, than any other which comes before the human mind.

But, even in those departments of our science which are free from these impediments, I cannot but think that the uncertainty and imperfection of our knowledge have been much over-stated, when the nature and extent of the subject to which it relates are considered, and the intrinsic difficulty of the study. In comparing medicine with other sciences, it seems always taken for granted that it presents a field about as extensive as each of the others with which it is compared. But this is a most erroneous view. Medicine embraces the whole science of living bodies. The phenomena of living bodies are much more various than those of inorganic bodies,—and so are the laws according to which they take place. The collection of physical sciences, then, which concern inorganic matter, are all together to be placed in comparison with the science which relates to the laws of living matter. The chemistry of life, for example, is as extensive and complicated a subject as the chemistry of the inorganic world; and so of the infinite motions which take place in a living body, and of the infinite relations which are maintained by means of the nervous system,—they are more numerous, more obscure, more complicated, than those existing among the inorganic bodies, which are the subjects of natural philosophy and astronomy. Now, when we compare the amount of labor which has been bestowed on mechanics, or astronomy, or chemistry, individually, with that which has been bestowed on medicine individually, these sciences are found in advance. But compare the whole of the labor which has fallen to the lot of Astronomy, Mathematics, Chemistry, Natural Philosophy, Geography, and Geology, on the one hand, with that which has been bestowed on Medicine as a science, on the other, and the progress it has made is rather a subject for pride than for humiliation.

There are still other points in this comparison which should be stated, in justice to the condition of our science. The properties forming the object of investigation in other sciences permanently appertain to the bodies which are their subjects. The affinities of these bodies, their chemical relations, their mechanical relations, their weight, their measure, their action on one another, are known and permanent. But you cannot examine life till you have destroyed it. The very object of your investigation escapes as the consequence of the first step of your experiment; the sacred fire goes out, as soon as you lay your hand on the materials by which it is supported. Suppose that the astronomer had been obliged always to examine a universe at rest; that the mechanical laws of the heavenly bodies must be suspended, and the sun, moon, and stars must stand still in their orbits, as a necessary preliminary in his investigation; the science of astronomy would then have been as difficult as the science of life.

In contrasting this, commonly regarded as the most perfect, with our own, which many are pleased to consider as the most imperfect of sciences, there is still another circumstance which contributes not a little to give to the former some of the comparative lustre which encircles it, namely, the immense distance of the bodies to which it relates, and the impediment which this is supposed to present to their examination. But is not this a fallacious view of the matter? The very fact of distance, instead of adding to the difficulty, diminishes it. It insulates them; it renders them more susceptible of exhibiting the amount and the laws of their mutual dependence. Astronomy relates to a few simple laws of matter governing the motions of bodies at a great distance, but still perfectly separated, and capable of a separate examination; their motions may be distinctly perceived and followed and measured,—all, in fact, are insulated, and free from extraneous and conflicting influence in consequence of their very distance from us and from one another. Distance among bodies thus uncomplicated is far less of an impediment, than are minuteness and indistinctness among bodies which are complicated. In this point of view, the investigations of the physiologist are encompassed by a thousand difficulties which do not embarrass the astronomer. The telescope is much easier of management than the microscope. It is easy to follow the stately course of a planet through the heavens with the former, to measure its motions, its rapidity, its deviations; but how hard to keep close on the tortuous track of a particle of blood by means of the latter. Many may smile at the assertion, perhaps some who hear me may be of the number; but, taking circumstances like these into view, I account the discovery of the circulation of the blood by Harvey, to have been hardly a less difficult and honorable achievement, than the true explanation of the motions of the heavenly bodies by Copernicus.

But, to return to the point from which we have thus digressed, while we admit that the confidence reposed in medicine is not what it was, is it certain that this is to be lamented? Should we desire to be regarded in the same light as formerly? to be held in the same kind of regard as in a less enlightened age? It would be a confidence unworthy of the age, unworthy of the present advanced state of the profession. It is true, that we need the confidence of mankind in order to our usefulness; but I am sure, that, when the history and character of the profession, and its present improving condition, are thoroughly understood, we shall receive, as I believe we deserve, a place in the estimation of the world more honorable and substantial, than ever before. It is only for the present, during a sort of transition period, when old relations have been broken up, and before there has been time for new ones to become established, that our position can be at all uncertain or equivocal. The following consideration, I cannot but think, has much weight, in enabling us to judge of the probable future destiny of our profession; namely, that whatever may be the currency of particular opinions, or the reputation of particular bodies of practitioners, the public will confide, mainly and habitually, in that body, or that succession, of men, who show themselves to be devoted to medicine, not merely as a means of getting a livelihood, or even as a means of treating disease and relieving suffering by the common routine of practice, but who pursue it as a great subject, all the relations and bearings of which it is their duty to investigate; who regard it as a science which they are deputed to build up and perfect; and who do all this, as diligent, earnest, and disinterested inquirers after truth.

It is this class of men, who, when they are fully understood, will receive the permanent confidence of mankind; and such, I undertake to assert, has been, and is, the essential character of our profession. Individual cases, it is unhappily too true, of selfishness, bigotry, narrow-mindedness, and prejudice, have so often occurred among prominent men, that the public have been sometimes almost ready to look upon these qualities as characteristics of the profession. But a glance at our history is sufficient to show how false is this estimate, and how different has been the character of those who have really been its lights and guides. Mankind are often disposed to reproach us, and we are sufficiently ready to reproach ourselves, with what we have failed to learn; but, if we examine into the amount of knowledge in medicine and its subsidiary branches which its votaries have accumulated, and at the process by which it has been accumulated, we have no reason to shrink from a comparison with any other company of philosophical observers.

Look at Anatomy and Physiology; the former, the most perfect of the descriptive sciences, the latter, though the most difficult pf subjects, bearing a fair comparison in its condition with any other. We cannot fully appreciate,—we can hardly imagine,—the difficulties with which they had to contend, who first investigated them, and have done the most, by laying a good foundation, to bring them to their present state of improvement. They persevered, century after century, not merely contending with the impediments growing out of the circumstances of the times and the imperfect modes of investigation then prevailing, but against prejudice and superstition and persecution. The state of human progress was against them.

Look next at the collateral branches. I do not claim for physicians the honor of having established the science of Chemistry, though I am not sure that we might not make out a strong case; but, during the greater part of its history, it has been much in their hands, and has derived its chief impulse and support from its connexion with them. They at least cherished the feeble steps of its infancy, though it has now the strength and courage to stand by itself. We may say nearly as much of Botany, of Zoology, of Comparative Anatomy, of Mineralogy, and of Geology. Strip these sciences of what has been contributed to them by physicians, or by those who have had the discipline of a medical education, and a chasm is left which it would be difficult to fill.

But, coming to labors more directly practical, to say nothing of the accumulated experience of those who have devoted themselves to the care of the sick in private life, follow those who have exposed themselves to privation and danger in a thousand forms, in the cause at once of humanity and of science. On the field of battle and in the camp; in hospitals and lazarettos and jails; in the midst of miasmata and contagion, of pestilence and death; whether in the torrid zone or in the frigid, on the land or on the water; wherever men have been carried by the love of wealth, of enterprize, of fame, of knowledge, or as ministers of religion, there have their steps been waited on by the members of our profession, ready at once to perform the offices of humanity, or subserve the cause of science; and, among the earnest and the faithful, who more earnest and more faithful? As the fruit of their various exertions, to say nothing of contributions to collateral branches of science, and of the relief of human suffering, and the saving of life, there has been accumulated an immense amount of knowledge upon subjects the most important to humanity; as, for instance, the causes and the laws of disease, the circumstances which promote or prevent its propagation, the laws of individual health and of public health, and the principles according to which the physical condition of man at all ages, and of communities of men under all circumstances, may be made to maintain the highest possible standard.

But we have a claim on the confidence of our fellow-men, not only for what has been done, but for the spirit in which it has been done. These services of the medical profession, upon the whole, have been among the most disinterested ever rendered to mankind. They have been distinctly governed by the desire of acquiring that knowledge which will confer practical benefits on society, without reference to the amount of reward, or to any fame except that of doing good. There is no better proof of this than the fact, already implied, that the aim of those who are most prominent in medical history, has been more to investigate the laws of disease, and thus to prevent it, and raise the standard of health, than to acquire reputation or wealth by what is far easier and more lucrative,—attention to the ordinary details of a medical practice. And, if it were necessary to introduce a more striking example of what is to be regarded as the governing spirit of those who are the true index of professional character, we have but to name the discovery and gift of vaccination to mankind by the illustrious Jenner.

In spite of all this, as I have already admitted, ours being a practical art which is necessarily connected with every rank and condition in society, it has of course happened, that, among that class of the profession who are engaged in its common details, a large proportion merely regard it as a means of earning their daily bread, or of acquiring property and consideration. To them, the practice of medicine is like the practice of any other occupation, selected and followed almost mechanically. Hence there are always to be found physicians of sordid minds and purely selfish views, who are yet high in professional rank and emolument. Such men, naturally enough, but unhappily for our good name, have often been the most prominent to the public eye, and have been the chief recipients of favor and patronage, just as it has happened in all other departments; and they have been thus sometimes taken as exponents of the character of the whole profession. But its true representatives are they to whose lives and labors I have just referred; and from these men the treasures of knowledge, which they accumulated in years of faithful and unceasing labor, have descended to us as our rich inheritance; possessed of which we should feel safe as to our future destiny, whatever may be the accidental and temporary alienation of portions of that public whom we serve, and whose confidence is so necessary to our usefulness. If we are faithful to the true character of our profession; if we go forward with honesty and fidelity in the path of our predecessors, governed by the same desire of knowledge and of usefulness, we need not fear but that the present movement of opinion will be transient, and that our position will become more firm and durable than before.

But, however confidently we may cherish this expectation, it is not the less our duty to look into our condition, and see if there be nothing in our institutions, our principles of action, our systems of education, which is either capable of improvement, or which requires more zeal, more earnestness, more perseverance, and more concert of action; and I propose, in the remainder of this discourse, to suggest briefly some of those considerations relating to the subject, a regard to which will have the effect, not only of elevating progressively the standard of medical education and character, but of bringing about in the community a better understanding of these, and a more just appreciation of the claims of the regular profession upon its confidence and respect.

One very important means toward this end is, to adopt an improved and improving standard of attainments for those who enter the profession; improved, because, although there have been vast accessions to medical knowledge in our day, the standard of education remains nearly where it was; improving, because, great as these accessions have been, the increase of knowledge, of valuable practical knowledge, is destined to be much greater in the next generation than it has been in the past. He, therefore, who now enters the profession, should not only be possessed of a greater amount of knowledge than his predecessors, but of a more cultivated capacity for the acquisition of knowledge.

It is worthy of consideration, then, whether there should not be required of those who enter upon the study of medicine a more thorough education in those elementary branches, which are preliminary to the right understanding of any scientific inquiry, even of the simplest kind. Is nothing more necessary, before entering upon some of the most difficult subjects, than a common English education? Is it merely necessary to be able to read and write our mother tongue, and that perhaps in a very imperfect manner? Are no habits of mental discipline, is no intellectual training, of advantage, before attempting to master subjects like those which engage the attention of the medical student?

But, further than this, is it not true that even the preliminary branches of medical study themselves are passed too slightly over,—Anatomy, Physiology, Chemistry, and especially Animal Chemistry? Are we not apt, in our haste to plunge into the practical branches, which are to be the business of our lives, to hurry over these elementary studies, without which there can be no proper comprehension of the more advanced ones? I can truly say, that, through the whole of my medical life, and under circumstances which have generally presented the strongest inducements to the acquisition of knowledge, I have felt constantly impeded and embarrassed by the want of thorough preliminary study; a want, which it is almost in vain to attempt to make up, amidst the labor and responsibility of our daily duties.

There is another deficiency which should be noticed, growing partly out of these original defects of education, partly out of the want of early habits of study, and of the consequent love of, and facility in, acquiring knowledge, and partly out of the mode of life which necessarily attends upon our occupation. We do not always, even so far as we might, keep up with the medical improvement of our age. How many of us continue to be faithful students and thinkers, after we have attended our last course of lectures, and obtained our credentials for practice? How many of us keep watch on the labors of those who are spending their lives in searching out new knowledge in medicine? With how many of us does our reading go much beyond that of a few elementary books, and of a few medical journals, and those not always of the highest and most instructive character?

I appeal to all those who have been in any way conversant in medical education, to those who have acted as the examining officers of this Society, to every individual in his own case, and in that of his neighbors, whether I have intimated more than their experience confirms. And if I have not, does it not become our duty gradually to remedy these deficiencies, to raise, and to keep up, the standard of medical education; to put ourselves on a level in this respect with the rest of the community in which we live, and to show them that it shall be no fault of ours, if we do not merit and receive their confidence?

I know there are many who are disposed to question the utility of some of the preliminary training to which I refer, and especially consider as useless those classical acquirements which form so large a part of a liberal education. But, for my own part, such is my estimation of the happy effects of such studies in general upon the minds of the young, in opening and cultivating their faculties, rendering them more susceptible of higher knowledge, giving them habits of acquisition, turning up the virgin soil thoroughly, as it were, before the seeds of life are sown, that I could wish every man who enters our profession had the advantage of a liberal education. This, in our community, is, to be sure, impossible; but still we ought to make as near an approach to it as is practicable. We should perceive its effects, not merely in the softening and ameliorating influence which it has upon the general character and manners, but in augmenting the capacity even for purely professional acquire merits, and in communicating a love of mental occupation, which will follow the physician, and never suffer him to be contented with the mere routine of his daily life.

There is no greater relief to the anxieties, or support under the responsibility, or refreshment after the toils of a medical life, than is to be found in a taste and capacity for some kind of reading and study. It may be the study of professional works only, though I cannot think a man is wise, or does justice to his own mind, who confines himself to these,—or the pursuit of some kindred branch of science, as Chemistry, Natural History, or Natural Philosophy;—or, instead of these, or, what is still better, mingled with these, an indulgence in that lighter taste which leads one to works of general literature, criticism, poetry, fiction; any of them is better than none, and all together better than anyone alone. But unhappily there is apt to be too little disposition for any of them in him, whose love of mental occupation was not formed and cherished before he entered upon the engrossing task of preparing for his profession, or, especially, before he became involved in its practical duties.

It will occur, perhaps, to some, that, by requiring a higher education, we are rendering entrance to medical life more difficult, and putting it out of the power of many persons of limited acquirements and narrow means, to gratify the ambition, so common among us, of enrolling themselves in the ranks of a profession. This is true. It will be made more difficult to become a physician. But is it not now too easy? It will diminish the number of those who become physicians. But is not the number now too great? I put it to the good sense of this audience, whether this objection has any weight. Is it any advantage to the profession, or to the community, that entrance into it should be very easy? Should the prizes of life be made so cheap? Do we not thus undervalue our calling? Is not the standard of professional character, as well as of acquirement, lowered by this facility of attaining its honors? Is not our profession injured, not merely as it regards the honest worldly reward of its laborers, which no man ought to pretend to despise, but is not its duty to the community imperfectly performed as a consequence?

It is, to be sure, popular to talk of making education cheap, and of making the avenues to honor and profit open freely to all. But this is said in a very loose way. It is said for effect, by those who have no definite idea of what they really mean. That education which is equally necessary to all,—to every occupation, the humblest as well as the highest,—should be made free to all. This the very safety of society requires. But, when we come to the education of men for particular stations in society, the case is very different. Even then, let the education be made as cheap and easy as it can be; but not cheap and easy by making it poor. Do not let us deluge the community with a flood of half-learned professional men, who drudge heavily through life, half employed, half paid, half starved, far less respectable in their vocation than a substantial farmer, an honest trader, or a skilful mechanic, because we choose to be blinded by a falsely so called republican maxim, which it may answer very well to bandy about at a political caucus, but which should never pass current with those, whose aim is the true respectability of their profession, and the real good of the community.

But, in order that we should deserve and perpetuate the confidence of mankind, not only is it necessary, that those who are to enter the profession should be highly educated; it is also necessary, that we, who compose it, should exhibit to the world a spirit of improvement and progress,—a disposition to employ faithfully all the means we now possess in the practice of our art,—and that, free from a primary regard to personal emolument and reputation, we should be ready to examine with a fair and candid spirit all and any suggestions, however they may arise, and from whatsoever quarter they may come, which hold out a fair promise of increasing those means.

And I must be permitted to say, that the character of our profession has often suffered in the opinion of mankind, and confidence in the real value of our knowledge has been lessened, by the spirit which has been frequently exhibited on this subject. There has sometimes been a want of liberality, a reluctance which must be called narrow-minded, not merely to admit, but even to look at the evidence of any new truths, and especially new modes of treatment, which present themselves out of the beaten track of medical observation. It has even gone farther than this, and the same disposition has shown itself, with regard to new things which have come up in the profession itself, especially if there happened to exist any of those petty jealousies, growing out of individual or local rivalry, which we so often suffer to blind and mislead us.

Now this disposition arises from a species of caution, good in itself and useful, growing out of a large experience of the fact, that, of new things, a great proportion are false, and that the evidence upon which most men rely as sufficient for proof, especially on medical subjects, is totally inadequate. But, still, new things are sometimes true, and we can only select these by an examination of all. And, even were we capable of determining, as we sometimes are, a priori, without examination, that certain things are false, we cannot place mankind in that position for observation which we occupy, we cannot impart to them those elements for judgment which we possess. We expect them to take our opinions on authority; but, in order to secure submission to authority, we must satisfy them that we are candid inquirers and impartial judges; we must be free from the suspicion of professional prejudice or jealousy. In order, then, to lead the opinion of the public in the matters which concern our occupation, we must be content, not merely to examine the evidence for the things which we think offer a fair show of probability, but for those which they think offer such a show. What may seem very unlikely to us, may seem very likely to them. What we even know to be impossible, they may be very ready to believe; and this, even among those who in their own pursuits are intelligent and well-informed. To secure their reliance on our opinions, we must, in making up a decision, put ourselves in their place, instead of expecting them to put themselves in ours. We must allow much for the circumstances under which they judge; much for their prejudices. Let us be sure that we do not yield to our own. We must be content to sift the chaff for their satisfaction, even when we feel confident there is not amongst it even a single grain of wheat to reward our search.

The disposition to which I have referred has often exhibited itself in the past history of medicine, and still continues to manifest itself in different ways, and in an irregular and unequal manner. We know how slowly and reluctantly assent was yielded to the discovery of the circulation of the blood, and how its author was subjected to obloquy, persecution, and even the charge of impiety. It was somewhat so with the great discovery of Laennec. How slow were many, especially the older members of the profession, to admit its value. By some it was received with doubt, by some with ridicule, and by some it was even declared to be impossible. But one of the most remarkable examples on record of this sort, is that which relates to the introduction of inoculation for small pox; and it is at once so curious and so instructive, that I cannot forbear recalling it to your attention. We, who have always lived in a community secured by the mild efficacy of vaccination from this loathsome pestilence, can know but little of its real horrors, when it prevailed unmitigated and unchecked. But we know enough to have taken it for granted that even such an alleviation of them as was promised by inoculation would be hailed as a gift from Heaven. But it was not so; inoculation met with the most strenuous opposition, not only from the vulgar and the prejudiced, but from the faculty themselves. ‘Nay all,’ says a biographer of Lady Mary Wortley Montague, ‘rose in arms to a man, foretelling failure and the most disastrous consequences.’ ‘We now,’ he continues, ‘read in grave medical biography, that the discovery was instantly hailed, and the method adopted, by the principal members of that profession. Very likely they left this recorded; for, whenever an invention or project, and the same may be said of persons, has made its way so well by itself as to establish a certain reputation, most people are sure to find out that they always patronized it from the beginning; and a happy gift of forgetfulness enables many to believe their own assertion. But what said Lady Mary of the actual fact at the actual time? Why, that the four great physicians, deputed by government to watch the progress of her daughter’s inoculation, betrayed, not only such an incredulity as to its success, but such an unwillingness to have it succeed, such an evident spirit of rancor and malignity, that she never cared to leave the child alone with them one second, lest it should, in some secret way, suffer from their influence.’

This picture is perhaps somewhat colored by the lively imagination of this celebrated woman, yet we have no reason to doubt, that it is essentially true. It may teach us a useful, though a humiliating lesson; and, though I trust there is less of such a spirit in an age so enlightened as ours, yet we see some exhibitions of the same sort in our own times; and there is scarcely any thing, which, as it appears to me, does more to lower the tone of public confidence in the profession, and excite distrust of its spirit and tendencies. It should be said, however, in justice to ourselves, on the other hand, that, although this illiberal reception has been given to new discoveries by certain individuals, at particular times, yet, with regard to things really valuable, such has not been the final judgment. Essentially, fairness, honesty, love of truth and of usefulness have prevailed; and justice, too tardy sometimes, it is true, has been rendered to them. The very fault to which I have referred, does in part arise from the very excess of these qualities; the fear of admitting that which is not true; an excess of that caution which is in itself right. It would not be easy to say which would be in the end most injurious to medicine, the credulity which eagerly seizes upon and appropriates every novelty that is suggested, or the incredulity which as decidedly rejects it at once, equally without any examination or inquiry.

You will readily perceive, and I am far from being desirous to conceal it, that these remarks have been suggested by the attitude the profession has assumed toward several systems, the current novelties of the day; which attitude has, I fear, had something of that influence on public opinion, to which I have referred. It is not necessary to state particularly what this attitude has been. It is sufficient to say that the systems to which I refer, that have been branded as the offspring either of folly or of imposture. This I regard as impolitic, for the reasons before mentioned; we cannot place the public in our position, or give them our materials for judgment;—and, as wrong, because, admitting these systems to be ever so wanting in truth, the history of human opinions shows us that there is nothing so absurd in doctrine or in practice, which has not been honestly believed by persons of intelligence and education. It is no doubt the case, that there will always be, among the adherents of a new system, many persons of quite an equivocal character. Some adopt it from a love of novelty or of notoriety, or from the desire of gain, or on account of the ease with which distinction is obtained among the proselytes of a new sect. But this would be the case with a system founded in truth, as well as with one founded in falsehood. Hence, although there are probably many unprincipled adventurers among the disciples of these new systems, I see no reason to doubt, that, as a body, they are governed by the same principles of action as the average of mankind.

The relation which we maintain towards systems we believe to be false should be determined by a principle which is most important in its bearing; namely, that there is no form of error, from the careful observation of whose origin and progress important inferences may not be drawn for the establishment of truth. Every kind of error has of course some truth, to which it is, as it were, the negative pole; the knowledge of one is necessary to the knowledge of the other. This is as applicable to medicine as to any other subject, perhaps more so. I will make its application to but a single one of the systems to which I have alluded, Homoeopathy. I select this, because it has been the most respectable in its origin and in the character of its advocates; because it originally arose in the midst of the medical profession; and because, in the opinion of many, it has done so much to shake the confidence of mankind in the old school, and, according to the prediction of many, is destined, in no very long period, to take its place.

As to its theory, there seems nothing in it more at variance with sound medical knowledge, than in those of Boerhaave or Cullen or Brown. It is just as good as those hypotheses which formerly divided the medical world, and no better. Like them, it is entirely destitute of legitimate evidence. But in considering the treatment of disease by Homoeopathic doses, that is to say, by quantities of medicine so small that even our imagination is at fault as to their actual existence, we find it difficult to conceive that any one, who has been used to observe the effects of remedial agents on the human body, or, indeed, the effects of any one agent on another, can believe in their influence as remedies. Yet it is certain that many intelligent and educated and honest men do so believe. It would not be difficult, also, to rake up, from the past, examples of belief in remedies quite as extraordinary, and supported by quite as little evidence. But those, you will say, were opinions held in an age when the laws of evidence were not well understood, and men were credulous because they were ignorant. But this statement is hardly supported by facts. The form of credulity varies in different ages; it may be concerned about different subjects; the real amount of it is always very much the same. It is the characteristic of certain minds, and not of certain ages. Its amount is by no means in proportion to the amount of ignorance. It may be more refined in one century, or in one class, than in another, but it is hardly less in quantity, and it appertains to men of the same cast of thought. There is nothing in the history of religious fanaticism in times past, more extraordinary than that of Millerism and Mormonism in our own times. There is nothing more extraordinary in the belief of our ancestors in witchcraft and fortune-telling, than that of some of our own brethren at the present day in the extravagances of Mesmerism. Lord Bacon believed in the efficacy of spells and amulets, and Sir Theodore Mayerne, the physician of three kings, in the remedial virtues of the heart of a mule who had been ripped open alive, and of the hand of a man who had been gibbeted. Are there not philosophers and lords and knights, who believe now in remedies, which, to the medical philosopher, present quite as little probability of efficacy as these?

But, although there are doubtless some who believe with perfect honesty, and after what they regard as a fair comparison, that the Homoeopathic is the true and most successful method of practice; still it is generally true, that men medically educated believe it to be entirely negative, and that patients thus treated, so far as medicines are concerned, are practically left to the resources of nature. Now, this being the case, it affords us a means of observing, on a large scale, the natural history of disease, as it goes through its course uninfluenced by the interference of art. The want of such an opportunity has been one of the greatest obstacles to the advance of the practical department of our profession. In its elementary branches, our science has improved, slowly perhaps, but with no uncertain steps; whilst in Therapeutics it has constantly struggled with the want of some standard of comparison. How can we judge what is the efficacy of any given method of treatment, unless we know what course disease will take without treatment? The want of this knowledge,—the knowledge of the natural history of disease,—has been the cause of almost all the uncertainty, the opposition, the vacillation in the management of disease.

This want it has been extremely difficult to supply in the ordinary course of practice. Approaches have been made to it with regard to a few diseases and on a small scale; but, in order to supply it thoroughly, it needs a long experiment on a large scale. Now, believing as we do in a greater or less amount of efficacy from our method of treatment, it has been impossible for us, conscientiously, to institute such an experiment; and the world would not support us in doing it, if we were disposed. But the Homoeopathists are performing, as we believe, this very experiment; and, fortunately, such is their confidence in their system, that they do it boldly, and can keep up, in this way, that reliance of their patients on their remedies which is necessary to the success of any treatment. It is only to be regretted that this same undiscriminating confidence on their part prevents the experiment from having its full value, since those who conduct it, and therefore might best observe it, do not scrutinize its results as philosophers, but merely gather them up as partisans. It is nevertheless our duty, without any feeling of rivalry or ill-will, to watch its progress as best we may, to avail ourselves of the fruits of what we regard as the errors of others,—as we ought to do of our own,—to enrich ourselves, as it were, with their spoils.

In a kindred spirit should we keep up a constant observation of the various attempts which are constantly making, sometimes by individuals and sometimes by bodies of men, to devise new methods of treating disease; and with a similar purpose of appropriating whatever may present itself which promises advantage. Every thing which happens to those laboring under disease,—everything which is made in any way to act upon them,—is capable, when accurately observed, of illustrating the laws of life, or of disease, or those according to which recovery from disease takes place. The more varied are the conditions under which the observations are made, the more rich will be the results; and, considered in this point of view, there is no mode of treating disease, however irregular, and in hands however ignorant, no delusion with regard to remedies, however strange, from such an observation of which useful knowledge may not be derived, either with regard to the history and treatment of disease, or, at least, with regard to the influence of imagination and prejudice upon its character and progress. All are experiments, which, though performed for no such purpose, should really be made to operate for our benefit. We are to consider that we cannot make them ourselves. With our knowledge of the accurate relations of disease, of the uncertainty of remedies, of the great powers of nature, and with that delicate responsibility to our patients, which imposes upon us the observation of the great first law in Therapeutics, ‘to do no hurt,’ we cannot run the sort of risk which such experiments imply; they require a recklessness of the result to which we cannot consent. When others choose to incur the responsibility of making them, it is right that we should reap the fruits.

In this way, I am convinced, we may, from time to time, learn much to aid us on the difficult subject of Therapeutics. We may find, that some modes of treatment which have been highly prized, have less connection with recovery from disease than has been usually imagined; and, on the other hand, that certain other measures may have been undervalued and overlooked. But, if this inquiry be always made in the calm and rational frame which should characterize the medical observer,—free from that turbulent spirit of animosity toward rival sects which we are too prone to indulge,—looking neither to the right hand nor to the left, to discover what the effect will be on our profession considered as a mere trade,—we shall be constantly adding to our stock of practical truth.

The same general principle is also applicable to the regulation of our conduct with regard to remedies, of whose composition, or mode of preparation, we are kept in ignorance. It is undoubtedly a fundamental principle of medical morality, that no medicines or modes of treatment, in short, no knowledge capable of beneficial application in medicine, which any one physician possesses, should be kept from his brethren, or indeed from the world at large. There are to be no secret means or medicines among us. Every thing is to be free and open as the air. Knowledge is the common property of the profession; and we would hold him up to universal scorn, who keeps any of it to himself, which can be made useful by others in the treatment of disease.

But this feeling, so just in itself, so honorable and so general among physicians, is carried too far, if it assumes that we should, in no case, permit the use of an unknown remedy, when the responsibility of keeping secret its composition or mode of preparation falls upon those out of the pale of the profession. This is an entirely different case. Our first duty unquestionably is to the sick. Whenever, therefore, we have good reason to believe, on such grounds of medical evidence as are usually sufficient, that any such remedy is capable of producing such beneficial results on disease as we know no better means of producing, the same professional philanthropy, the same sense of duty to our patients, obliges us to employ it.

The adoption of any such remedy or mode of treatment by a regular member of the faculty is regarded, if not exactly illegal, yet at least, as being somewhat unprofessional, and certainly it is a course to be avoided if practicable. Still, in a great many cases, articles have been received and taken into regular professional use, although their peculiar composition or mode of preparation was unknown, because they were found better adapted to fulfil certain indications of treatment, than any of the compounds of the Pharmacopœia. But,—without mentioning particular examples of this sort, which must be familiar to those conversant with medical history,—to put a very strong case, suppose it had happened that the insensibility to pain which follows the inhalation of sulphuric ether had been produced, as was at first supposed, by some newly discovered combination of articles, the knowledge of which was concealed from us. Will any one say, that, if a reasonable probability had been established that this was actually the result, we should have hesitated to give it a trial, and to employ it, if found successful? I trust not. It would have betrayed a sort of atrocity like that, which would have strangled vaccination in its infancy for a similar reason. On the contrary, we have reason to congratulate ourselves that it received among us so ready a trial, even when some mystery was still suffered to hang over its composition; that the prominent persons, especially, in that department of practice in which, thus far, it has been chiefly useful, were so prompt to give a hearty welcome to what will probably prove to be the most important discovery in medicine since the introduction of vaccination.

I admit that this subject should be watched with much jealousy; that such remedies should be resorted to with great caution, and only where there is a reasonable probability that we can thus treat disease better than by our ordinary means. It is to be kept in view, also, that, where the nature and composition of an article are unknown to us, we should require a more careful scrutiny, a more complete array of evidence, than where a knowledge of its origin or composition aids us to judge, from analogy, what its effects are likely to be. So, too, it should always be understood, that the principle of concealment is utterly at variance with our professional code. With these limitations, the ground I have stated is not only that of the letter and spirit of our regulations, but is the only one consistent with that regard for the public good, which must supersede other considerations.

There is still another subject somewhat connected with these, namely, the relation in which we stand to irregular practitioners, or to quackery. There is much sensitiveness on this point; many are warmed with a very earnest zeal for putting it down, and we are often met by the inquiry, ‘Can we do nothing to exterminate it?’ But we are to recollect, in making up our judgment as to our proper course, that there are circumstances which render its existence, in some way or form, almost a necessity. There are many persons, who, from their natural temperament, and there are many others, who, under the influence of disease, cannot be satisfied with the steady, sincere, and unpretending management which the self-respect of the regular practitioner obliges him to adopt. They require to be encouraged by hopes which are to prove fallacious, by promises which are to be broken; to be soothed and kept patient by a thousand flattering arts, which those who understand disease and can really foresee its course, and who feel bound to honesty of purpose and deportment, cannot employ. Hence a resort to quackery is almost essential to this class of patients. Happy it doubtless is to many of them, that they can have recourse to those whose ignorance, or whose conscience, does not prevent them from pretending to knowledge which they do not possess, or from professing to accomplish that which we know to be impossible.

It was formerly the case, before the limits of our knowledge were so well ascertained, and before the proper decorum of the profession was so well settled, that there were many among the accredited members of the faculty, who held, to all intents and purposes, the same relation to the sick, that this class of practitioners now do. Quackery, it is to be remembered, does not principally consist in using medicines of a particular kind, but in using any medicines in a particular way. The quackery is not in the character of the drug, but in that of the man. Quackery may strut with a doctor’s diploma, or seat itself in a professor’s chair, as well as ensconce itself behind piles of boxes and rows of bottles, and boast of its miraculous cures through the columns of the press. But whilst, with a gradual improvement in the standard of professional character, this class of men has diminished in our ranks, they have been increasing out of them; and, though other circumstances in the altered condition of society have partly contributed to this result, I believe that one great cause why there is more quackery out of the profession, is because there is less in it. Though we may hope that it will diminish with the increasing respectability of our profession, and with a better appreciation of its character on the part of the community, we cannot flatter ourselves that it will become extinct, since it is founded on an essential infirmity of human nature, and one which exhibits itself on other subjects,—on religion, politics, and education,—as well as on medicine. This is, then, a subject on which it is neither for our interest nor for our dignity to interfere. Any sensitiveness, and more especially any action on our part, whilst they are sure to be inefficient, are also likely to be misunderstood. They magnify the importance of this class of practitioners, and are apt to be attributed to jealousy of their success, and to our fear of being supplanted in the favor of the public.

In the remarks which have been made, my object has been to bring up for our consideration certain principles which should guide us in reference to the welfare of the profession, rather than to point out any definite course of action, or to speak of particular measures. These naturally present themselves, from time to time, to those to whom the guardianship of our institution is committed; and if we are governed by a true professional spirit, a determination to be true to the character of those who have preceded us, we need not fear but that our future progress and condition will be such as to do no discredit to the honorable recollections of the past.

For, as I have already endeavored to show, the past history of the profession has been honorable, and it has always been devoted to the best interests of truth and humanity. It is true, various sects have arisen within its bosom, exhibiting, as sects always do, bigotry, prejudice, and intolerance; strange opinions have been entertained; an infinity of modes of practice have prevailed, some good and some bad. Bad men, ambitious men, men of a selfish and mercenary spirit, have frequently presented themselves, have often become prominent, have, for a time, impressed too much of their own character on medicine, and thus proved obstacles to its advancement. But, in spite of all this on the surface, it is astonishing to remark how distinctly the under-current has always been directed by the ruling principles of honesty and humanity. How thoroughly has age after age sifted the materials which have been presented to it. How certainly, one after another, every form of falsity, which had for a time usurped a place amidst the accredited knowledge of our profession, has been suffered to pass into oblivion, whilst whatever was true has been preserved amidst its treasures.

And such will continue to be the case. We have seen, in our day, this process going on, by which the truth, though doubted, and subjected to a severe ordeal, maintains its place; whilst from error, though discarded, lessons of value are still educed. It was in conformity with this uniform tendency, that the great discoveries of Laennec, though received with doubt and hesitation, were, after careful scrutiny, accepted and recognized as of inestimable value. It was also in conformity with it, that the Theory and Practice of Broussais, though at one time received by a considerable portion of the medical world almost with acclamation, has not had enough vitality even to survive its author, though it has served, by the indirect lessons it has taught us, to modify, in a most important manner, various views of pathology and practice. No matter what sects arise about us holding new opinions of disease, or advocating new modes of practice. No matter how much they may, for a time, make their way into public regard, and contend with us for the favor and confidence of mankind with apparent success. The same will be our history in regard to them, the same will be their fate. From our very character and constitution, we shall be a permanent body; they, transient and evanescent. Our profession always has, gradually, and slowly, and sometimes perhaps reluctantly, selected and absorbed all the truth, rejecting the falsehood which has arisen within and around it. This process will continue. New sects will arise and decline, and others will take their place; but, so far as they advocate any just opinion, or originate improvements in practice, or illustrate important errors, the lessons they teach will survive amid the accumulated treasures of medical knowledge. Other systems will pass away,—ours will be permanent; nourished indeed to some extent by the very elements which come from their decay, as the eternal oak flourishes and grows green for ages from the decomposition of the transient vegetation, of which generations are springing up and perishing around it.

These are serious convictions on a serious subject, a subject which has excited much attention and some solicitude. It is indeed of the deepest importance to every one who sees in his profession any thing more than a mere trade by which he is to earn his daily bread;—it is even of some moment to him. It should not pass from our mind amid the appropriate festivities of this day, nor be forgotten amid anxieties and pressing cares which await us in the labors of to-morrow. It should dwell with us, and retain its hold on our attention. We have, with regard to it, an interest and a duty; and it will be found in this, as in most other cases, that our duty is the surest guide to our interest. To establish a high standard of professional education, to give a true elevation to professional character, these should be our great purposes, as individuals and as a Society; and, if we accomplish these, a variety of others, important in themselves, will be made easier of attainment, even if they are not incidentally brought about, which is in truth most likely to be the result.

Do we propose to secure for professional labor a fair remuneration?—We cannot hope to effect this, unless we satisfy the community that we send out no candidates for their patronage, who are not qualified to claim it. Do we design to put down quackery?—We can do it most effectually by raising up regular medicine. Is it our aim to prevent our being supplanted by new systems?—Let us take means to make the world understand that the old is better. Do we wish to prevent all intercourse between regular and irregular practitioners?—We should make the distinction so marked between them, in education, manners, and character, that they cannot intermingle. Do we desire to bring all those in this Commonwealth, who have been regularly educated, and desire to practise medicine honorably, within the limits and under the influence of the Society, a consummation which is essential to the full accomplishment of its purposes?—Let us, as far as time, space, and the necessary impediments of intercommunication render it practicable, make its presence every where felt, and its benefits every where equally diffused.

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